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Sunday, October 21, 2012

Book Review: "The Comfort Garden: Tales From the Trauma Unit"

Once in a while, a book comes along that makes one look long and hard at one's own relationship with work, the role of the caregiver, and the ways in which caring for others can take a toll on one's own personal and professional life. Laurie Barkin's "The Comfort Garden: Tales From the Trauma Unit" is a heartbreaking, inspiring and deeply thoughtful book that has done just that for me--and so much more.

Chosen by the American Journal of Nursing as the 2011 Book of the Year, "The Comfort Garden" details five years of Barkin's life working as a psychiatric nurse on the Med-Surg unit at San Fransisco General Hospital. Her job description included --among other things--running support groups for trauma survivors, visiting hospitalized patients who have been impacted by myriad traumas, and intervening in acute situations requiring her vast compassion and expertise.

Using patient vignettes and stories to illustrate her own internal process, Barkin also reveals deeply personal aspects of her own life--and the lives of her family--as she describes how her work in the trauma unit wore slowly wore away at her own stores of inner strength.

Barkin's compassion, caring and experience of vicarious trauma draw the reader in with the words and voice of a truly talented and thoughtful writer. Her ability to vividly describe patients, colleagues, the workings of the hospital's psychiatric services, as well as her own rich family life all combine to make "The Comfort Garden" a compelling and memorable read.

Ms. Barkin finds comfort in nature, her children, and the joys of family and friendship, and she truly attempts to practice what she preaches by escaping the rigors of her vocation in order to renew her soul. Still, we learn that the inexorable effects of the trauma experienced by her patients haunt her in both waking life and her dreams. Even so, her compassion leads her to continue this challenging work.

A part of me would love to climb that majestic tree, to be above the world, oblivious to the pain of others. But I've never been able to stay in a place like that, alone and unengaged with the world.

Apparently, the author was able to use her therapeutic experiences with patients for her own personal growth as well, and she deftly translates those internal processes for the reader's benefit.

From that moment, I was hooked. Knowing I helped someone made me feel better than I had ever felt in my whole life. "Being with" Sean in his suffering--witnessing and appreciating his pain--helped to crack open the frightening and lonely world into which he had retreated. I wanted to know more about that world, and how to help people like Sean. As an added bonus, maybe I would learn more about myself in the process.

In the course of "The Comfort Garden", Ms. Barkin address the vagaries of managed care, the internal politics of the hospital and psychiatric service, her interactions with colleagues, as well as her own feelings about her workplace, colleagues and professional relationships. She does not hold back in her criticisms of her "superiors", and openly questions the system itself, especially the ways in which the system fails the very nurses and workers who keep it running so seamlessly. This "institutional denial" is one of the themes woven skillfully throughout the book.

When I gaze at the hospital and think about the sad stories within those concrete towers, the towers seem to sway. I imagine their windows bursting open, and keening, wailing voices flowing over the ledges, oozing down over the city. Emotion needs to release. So exactly how is it, I wonder, that our department of psychiatry--full of highly educated people who understand emotions, their role in stress and disease and the benefits of talk therapy--can so easily fail to take its own medicine? How can caretakers be expected to contain our very human feelings and reactions when our patients tell us about the trauma, neglect, and depravity they have endured throughout their lives?

Ms. Barkin shares quite starkly how her patients' experiences and stories invade her own psyche, and how she struggles to remain afloat amidst the melee. "The Comfort Garden" is thus a cautionary tale for any nurse or caregiver who eschews self-care in the face of such vicarious traumatization.

Maybe the job has gotten to me. Maybe I've begun to turn off my feelings the way I've seen other nurses do.

Choosing to share her own painful process of self-realization, the author opens the door for the reader to identify with her experiences. Barkin speaks what some nurses feel but never communicate or fully recognize.

And what about the rest of it? Why don't you tell them about your nightmares or how your heart pounds on your way home from work wondering if the kids are safe and that you feel something close to panic just before you unlock the door?

As much as the author recounts her own tales of self-discovery amidst her struggles, she also is certain to share her successes, the tender moments, and the times when her work seems incredibly worthwhile, filled with the pain, joy and challenge of human existence. Her descriptions of her therapeutic relationships are poignant, and the therapeutic process is duly honored.

It strikes me now that therapy is a kind of grafting; a therapist extends a sturdy root structure and healthy tissue toward her patient. In the process of severing the diseased parts, the patient binds herself to the therapist's tree, borrowing healthy tissue for re-growth.

And again, her optimism shines through the gritty realities of patients' lives:

We listen for the echo of a deep well of faith, optimism and hope. Hearing those life-giving gurgles gives me confidence that my trauma patients will survive the journey ahead.

Laurie Barkin has given nurses and other caregivers a story that is at once moving, instructive, poignant, masterfully written, and an apt description of the effects of trauma not only on those who suffer it, but those who care for them.

"The Comfort Garden" is a jewel of a book by a nurse whose caring, compassion and keen introspection are evident in every page, infusing the narrative with a deeply moving personal story to which many nurses--from psychiatry to Med-Surg--will no doubt relate.

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As always, I received no payment of remuneration from the author or publishers other than a review copy of "The Comfort Garden".

Ms. Barkin can be reached through her website, and her interview on RN.FM Radio on October 22nd, 2012 can be accessed here.

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